Profile of a Malignant Brain Tumour in Jamaica: An Eight-year Review, 2005 to 2012.

OBJECTIVE: Glioblastoma multiforme (GBM) is the most malignant and most common primary brain tumour worldwide. This study was undertaken to investigate the demographics of this tumour in Jamaica as there is to date no such published data. Data from the recently started Intracranial Tumour Registry (ITR) at the University Hospital of the West Indies was used. METHODS: All cases of GBM entered into the ITR between 2005 and 2012 were gathered. Of these, only patients with pathologically proven diagnoses were entered into the study. Demographic data, including age and gender, were recorded. The distribution of the tumours by anatomic location was also documented. RESULTS: Of the 602 patients entered into the ITR up to that time, 42 were found to have histologically proven GBM with a male to female ratio of 2.2:1. There was an age range of 8-92 years with a mean age of diagnosis of 48 years. The majority of the tumours (66.7%) occurred in the left cerebral hemisphere with the most common lobe being the temporal lobe. Two patients (4.8%) had lesions spanning both hemispheres. CONCLUSIONS: This preliminary study reveals that there is a similar gender distribution of GBM within our population compared with the rest of the world. It, however, revealed that the mean age of diagnosis in our population (48 years) is lower than that quoted in the worldwide literature (53 to 64 years). One possible explanation for this is the possibility that many of our GBMs are actually secondary tumours which are thought to arise from less malignant, undiagnosed precursors. The percentage of GBMs occurring in the paediatric population was similar to the rest of the world.

Ageing of Jamaica's Population -- What Are the Implications for Healthcare?

The 2011 Census has confirmed the ageing of the Jamaican population. The over-60-year-old population has increased while the under 15-year population has decreased. Other demographic changes of note include the largest increase being in the old-old who are predominantly female. The demographic changes when considered with the increase in chronic disease indicate the need for consideration of healthcare specifically targeting the needs for older persons including increased prevention, continuous medical management, long term care and caregiver support.

A clinical audit of the management of acute asthmatic attacks in adults and children presenting to an emergency department.

OBJECTIVE: To compare the guidelines in the University Hospital of the West Indies (UHWI) acute asthma management protocol with actual practice in the Accident and Emergency Department. METHODS: A prospective docket audit was done of all consecutive medical records of patients, presenting with a diagnosed acute asthmatic attack between June 1 and September 30, 2010, to the emergency department of the UHWI. A convenient sample was used. The audit tool used was created from the UHWI protocol for the emergency management of asthma in adults and children, as well as the British Adult Asthma Audit Tool. The audit tool assessed three main sections: initial assessment, initial management, and discharge considerations. Data were coded and entered in Microsoft Excel 2007 and statistical analyses conducted using Stata version 10. Management patterns were compared to the actual protocol and then discussed. RESULTS: A total of 15 864 patients were seen during the study period. Of these, a total of 293 patients were seen for a presentation of acute asthma. More females (57.3%) than males were seen, with the mean age of 33.53 years. Only 31% of patients were given a severity assessment of mild, moderate, or severe. Peak expiratory flow rate (PEFR) was attempted and recorded in 62%, but only 18.1% of patients had both pre and post PEFR done. Only 4.4% of patients were administered nebulizations within the suggested time frame. Positively, 94.2% of patients were given a prescription for inhaled corticosteroids and bronchodilators to continue post-discharge. CONCLUSIONS: Acute asthma management still remains an area of medical practice that continues to have long-standing difficulties. Failure to assess and document the severity of asthma attacks along with the under-utilization of PEFR was noted.

The compliance of healthcare workers with universal precautions in the emergency room at the university hospital of the west indies.

OBJECTIVES: The study assessed compliance among health workers in the Emergency Room at the University Hospital of the West Indies with universal precautions. This was done by determining the knowledge, practices and perceptions of staff of universal precautions and by assessing compliance. Reported adherence with universal precautions was compared with observed practice. METHODS: This was a cross-sectional study conducted over a one-year period. It was approved by the University Hospital of the West Indies/University of the West Indies/Faculty of Medical Sciences Ethics Committee. Data were analysed using Stata version 11.1. RESULTS: During the study period, 67 persons gave consent for the study, data were obtained for 62 of these participants and 52 of the respondents were observed. All of the participants were aware that universal precautions related to blood. Eighty-six per cent erroneously thought that universal precautions apply to urine. Seventy-nine per cent of the participants reported always washing their hands after performing a procedure and 43.5% reported always washing their hands before a procedure. Just over half of the participants reported always wearing gloves while doing procedures (56.5%). Only 9% reported always using a gown with a trauma patient. However, 31% and 43.3% reported wearing a gown when placing a chest tube and when anticipating splashes, respectively. Of those participants who reported washing their hands often after a procedure, over 30% did not perform hand-washing when observed. Fifty per cent of persons that reported never recapping needles were observed to recap needles by hand. CONCLUSION: The study revealed that compliance among staff in the Emergency Room with universal precautions was unsatisfactory. The need for education in this area was recognized.

Hypertension and Diabetes Prevalence in Older Persons in Jamaica, 2012.

The Jamaican population is experiencing both a demographic and epidemiological transition. This 2012 study of 2943 community dwelling persons over sixty years of age sought to determine the prevalence of hypertension and diabetes and how it has increased since the earlier 1989 study. Hypertension was the most prevalent non-communicable disease with 61.4% and had increased from 41.4% since 1989. It increased with age and was more common in females than males. Diabetes, at 26.3%, was the third most prevalent; it had increased by 157.1% since 1989. While the majority of affected persons were on medication, control of both diseases was less than adequate. Obesity was associated with both diseases. The paper discusses the implications for healthcare systems.

Sociodemographic factors associated with depressive symptoms among elderly persons from two communities in Kingston, Jamaica.

OBJECTIVE: To explore possible associations of age, gender, socio-economic status, educational level and level of cognitive functioning with depressive symptoms in a community sample of elderly persons. METHOD: Two hundred elderly persons from two communities in Kingston, Jamaica, were randomly selected for participation in the study. They or their caregivers provided sociodemographic information and participants also completed the Zung Self-rating Depression Scale (ZSDS) and the Mini Mental Status Examination (MMSE). Variables of interest were entered in a multiple variable regression model using ZSDS score as the outcome variable. RESULTS: Predictors of depression were older age (B = 0.26, se = 0.08, p < 0.01), female gender (B = 3.98, se = 1.44, p < 0.01), low socio-economic status (B = 5.14, se = 1.50, p = 0.01) and low level of cognitive function (B = -0.38, se = 0.18, p < 0.05). No statistically significant association was found between educational attainment and depressive symptoms. CONCLUSION: The findings highlight the need for further exploration of the extent to which the associations identified are relevant for the overall population of elderly persons as well as the potential value of targeted preventive and treatment interventions.

Prostate cancer in Jamaica and the wider Caribbean: it is time to consider screening.

Prostate cancer is a serious health problem in the Caribbean with high incidence and mortality rates affecting a predominantly Black population. Research is required to help elucidate the importance of locally relevant modifiable risk factors so that preventive strategies may be instituted both at the population and individual levels. Also, effective secondary preventive strategies such as mass screening and other interventions should be urgently considered to bring this common disease under control and reduce not only the mortality but the morbidity and accompanying caregiver burden.

The establishment of an intracranial tumour registry at the University Hospital of the West Indies.

In March 2010, the first intracranial tumour registry (ITR) in the English-speaking Caribbean was started at the University Hospital of the West Indies (UHWI). This was deemed necessary as the already established Jamaica Cancer Registry only reports on malignant brain tumours. The ITR will collect data on all prospective intracranial tumours, benign and malignant, which are diagnosed histologically at the UHWI. Retrospective information dating back five years was also collected. Data collected so far reveal that between the years 2006 to 2010, a total of 317 cases were entered into the database. Of these, only 45 cases were considered eligible. The issues surrounding this discrepancy are discussed in this paper along with the many challenges experienced in the establishment of the ITR. From these experiences, the authors have also put forward several recommendations that may be useful to other researchers who wish to implement similar systems.

Mental health policy and service system development in the English-speaking Caribbean.

The countries and territories comprising the English-speaking Caribbean (ESC) have made some strides in the development of mental health policy, services and systems with the expenditure in mental health as a percentage of health budgets ranging from 1% to 7%. The ESC countries have well developed primary healthcare systems. However mental health legislations in many countries are in need of reform. Some countries have developed an innovative community based, secondary care treatment model: treatment in the medical wards of general hospitals. These countries have made progress in integrating mental health into primary healthcare and have made psychotropic medication widely available at the primary care level. Notwithstanding the progress in some countries, greater effort is required in phasing out mental hospitals and integrating mental health into primary care in other ESC countries.

Decriminalization of marijuana: is this a realistic public mental health policy for Jamaica?

Marijuana has potential benefits and adverse effects. Despite its popularity in Jamaica, decriminalization may not be possible given the international and regional obligations of Jamaica.

Health status and health-seeking behaviour of Jamaican men fifty-five years and over.

OBJECTIVE: The Caribbean including Jamaica is undergoing rapid population ageing with implications for health service planning and delivery. Such planning should take into account gender differentials. This study describes and analyses the health status and health-seeking behaviour of men 55 years and over in Jamaica. METHOD: A quantitative cross-sectional survey employing cluster sampling techniques was utilized to recruit 2000 men, 55 years and older in the parish of St Catherine, Jamaica. A 126-item questionnaire was administered and standard instruments utilized to assess functional status. RESULTS: Respondents (74%) rated their health status as excellent/good. Few men were highly dependent with regard to Activities of Daily Living with incontinence being a major concern. Medication management and shopping were the major Instrumental Activities of Daily Living domains where assistance was needed. Depression was associated with non-involvement in community/social organizations and not being in physical contact with their children. Major health conditions reported were cancers (16%), kidney/bladder conditions (12.7%), hypertension (9.2%) diabetes (6.5%) and prostate problems (7.3%). Most men (67.6%) had not visited a health provider in the year prior to the survey; 17.1% had been hospitalized after age 55 years. Only 35% of men ever had a prostate check/examination and 8.2% of men eligible for drug benefits under the Jamaica Drugs for the Elderly Programme registered for that programme. CONCLUSION: There is need to focus on older men's health and ensure that primary prevention and early interventions reach middle-aged and older men while improving health literacy. Taking programmes to 'where men are" is suggested--the bars, race track and sports events. Gender and age-specific research should reduce gender disparities in health among older persons in Jamaica.

Are parents in tune with music their adolescent children enjoy? Are there missed opportunities for sexual and reproductive health dialogue?

UNLABELLED: The perspectives of adolescents were solicited on the issue of sexual and reproductive health messages they received through dancehall music as well as their perceptions of parents' views of such messages and adolescents' indulgence with this genre of music. METHODS: This sequential mixed methods study was completed in 2008. The study's qualitative component was summarized as the novel ALODAC (Ask, Listen and Observe, Discuss, Analyse and Confirm) model, involving a series of steps to engage adolescents 10-19 years to share their perspectives on sexual and reproductive health messages enunciated in the dancehall music to which they listen. The quantitative component saw 1626 adolescents in public schools responding to an interviewer-administered questionnaire which included questions about their families and how they respond to dancehall content. Five messages determined from content analysis of songs on adolescents' music menu were used to initiate discussions with adolescents about the issues. RESULTS: Almost equal proportions of respondents in the survey lived with either their mothers (37.3%) or both parents (35.6%). Most adolescents reported enjoying dancehall music and learning specific messages even when some parents were against use of such music. There were significant gender differences observed regarding perceptions about parents agreement with lyrics on transactional sex (p < 0.001), prevention of pregnancy (p < 0.01), condom use (p < 0.01) and multiple relationships (p < 0.01). CONCLUSIONS: Whether or not parents are in tune with the music their adolescent children listen to does not seem to affect the pleasure and lessons adolescents gain from this medium. Opportunities for discussing sexual issues common in Jamaican dancehall music exist but are missed.

Chronic disease and ageing in the Caribbean: opportunities knock at the door.

Amidst rapid population ageing, the incidence and prevalence of chronic diseases and their sequelae demand reflective and critical looks at the issue and the subsequent development of informed age-sensitive responses. This paper reviews the burden of chronic diseases in the Caribbean, and its relationship to ageing and the demographic transition. Inter-linkages between the social determinants of health, poverty, ageing, and chronic disease are illustrated. Suggestions are made regarding directions to be pursued and the emerging initiative regarding chronic non-communicable diseases being spearheaded at the United Nations by CARICOM countries

Integrating mental health into primary care an integrative collaborative primary care model--the Jamaican experience.

Many low-income countries face enormous constraints which limit the development of mental health services. The World Health Organization (WHO) made ten recommendations to facilitate the development of mental health services; among these is the integration of mental health into primary care. Jamaica developed an integrated collaborative system of mental health care through the adoption of a primary care model which is central to the delivery of mental health care. This model emphasized the integration of mental health into primary care and, in expanding the role of the mental health team, made it more collaborative. Mental health services were mainstreamed into primary care and several strategies facilitated this process. These included the training of staff in primary care, the availability of psychotropic medication in primary care facilities and the provision of mental health beds at the community level. Furthermore, focus was placed on human development and the involvement of consumers in the policy development and service delivery. This has resulted in a reduction in the population of the mental health hospital and expansion in the community mental health services.

Prevention for better health among older persons: are primary healthcare clinics in Jamaica meeting the challenge?

OBJECTIVES: The study sought to determine the level and type of preventive care offered to older persons (persons 50 years and over) in the primary healthcare system and to identify the barriers to prevention-related activities. METHODS: The study was carried out in three phases utilizing quantitative and qualitative methods. Quantitative data were collected over a six-week period from 738 older patients accessing health centre curative services and from 86 health centre staff Focus group discussions were used to obtain information from non-users of health centres. RESULTS: The findings showed that while clinical practice was good, there were relatively inadequate levels of prevention care practices and there were barriers to prevention-related activities for older persons in the primary healthcare system. Only 5.1%, 24.5% and 9.6% of older persons reported being advised about smoking, physical activity and alcohol consumption respectively by health centre staff A higher proportion (56.5%) reported being advised about diet. Older persons did not appear to understand the role of prevention in maintaining health status. Barriers identified include inadequate numbers of staff overcrowded clinics, rapid staffturnover; high costs of investigations and medications, and poor staff perception of older persons 'abilities to care for themselves. CONCLUSION: Health promotion and secondary prevention for older persons in the primary healthcare clinics need strengthening. Training and facilitation of health workers in age-related age-specific prevention activities are recommended. The provision of appropriate resources for prevention activities among older persons in primary healthcare settings should be addressed.

Competition for adolescents' sexual and reproductive health values: is the media winning?

OBJECTIVE: This study aimed to understand the sources and content of sexual and reproductive health (SRH) information among Jamaican adolescents. SUBJECTS AND METHODS: A national survey of adolescents 9-18 years old attending public schools in Jamaica was done using multi-stage stratified cluster sampling techniques. Questions included in a 57-item questionnaire assessed adolescents' awareness of SRH messages promoted by the Ministry of Health (SSRHM) and through Dancehall, (DSRHM). The data were analysed using the Statistical Package for the Social Sciences (SPSS) Version 12.0. Descriptive statistics were used to summarize the data and relationships between variables tested using bivariate: analysis, with a 'p' value of 0.05 accepted as significant. RESULTS: The mean age of respondents was 12.8 (+/- 2.06) years for boys and 12.8 years (+/- 2.23) for girls. Television (76.9%), radio (55.4%) and guidance counsellors (55.2%) were the most common sources of SSRHM with no statistically significant demographic differences. Condom use was the only SSRHM, among the seven assessed, that was reported by more than half of the respondents (85.4% boys and 80.3% girls, p = 0.025). Half the number of the male specific DSRHM assessed was reported by more than 50% of boys. Hurting men who have sex with men, and having many girlfriends were the leading messages reported (69.8% & 65.3%). Among girls, five of nine female-related DSRHM were reported by most girls. Having relationships with males who have material resources (66.8%) and being independent (64%) were the leading messages reported. CONCLUSIONS: The electronic media was the leading source of SSRH messages and condom use was the only SSRHM that outstripped the variety of gender specific DSRH messages, some of which contradict standard messages.

Adolescent ears: an avenue into their sexual and reproductive health values.

OBJECTIVES: This study sought to understand what sexual and reproductive health messages Jamaican adolescents get via Dancehall music and how themes in these messages can inform the development of a questionnaire for further exploration of the subject. METHOD: Qualitative processes: key informant interviews, content analysis and focus group discussions were used to identify the themes heard in Dancehall songs to which adolescents listen. Adolescent investigators were utilized to enhance the communication flow among their peers while the adult investigator coordinated the analysis process. The data generated by each method were analysed manually and the themes used to inform development of a quantitative questionnaire for further study. RESULTS: Of 43 songs identified by key informants, twenty-five were short-listed as Dancehall songs as they having met the criteria for conveying sexual and reproductive health and relationship themes. Most themes were gender specific with male specific messages relating to sexual roles and behaviours, physical sexual attributes and performance and sexuality related violence. Female specific messages were about female behaviours in a sexual relationship, financial stability and independence in relationships and physical sexual attributes. All themes were confirmed" through focus group discussions and additional information gleaned about how adolescents perceived the meanings and context of some expressions in the songs analysed. These themes informed the development of a questionnaire in both language and content. CONCLUSIONS: Gender specific issues about sexual relationships and performance, physical sexual attributes and sexual violence were common themes identified in Dancehall songs listed by adolescents. Focus group discussions confirmed adolescents' listenership to the themes and provided explanation of the perceived context and meaning of some messages.

Health status and health maintenance practices among doctors and nurses at two hospitals in Jamaica.

The health of doctors and nurses is of paramount importance because they must be well to perform their jobs optimally under difficult conditions. However, the challenge of their working environment and the culture of their professions often lead to physical and mental illnesses. Despite this, there are several barriers to doctors and nurses seeking healthcare. In this study, the health status and health maintenance practices of doctors and nurses at two hospitals in Kingston, Jamaica, were assessed. This population was previously reported to have a 27% prevalence of probable mental distress based on the General Health Questionnaire 30 (GHQ30). Two hundred and twelve doctors and nurses were recruited into the study. The reported prevalence of chronic diseases was determined while mental health status was based on the GHQ30, reported signs and symptoms of stress and job satisfaction. Health maintenance practices studied included, health-seeking behaviour willingness to seek counselling, reported source of emotional support and use of alcohol and tobacco as coping strategies. Although, less than 50% of study participants reported that they were satisfied with their job, the mean number of days missed from work in the "last six months" was less than two and a half days. The mean time for "last doctor's visit" for nurses and doctors in the current study were 0.93 and 2.4 years, respectively. Females were more willing to seek medical attention than males. More than 50% reported signs and symptoms of stress and major sources of emotional support were friends (55.7%), followed by spouses (36.0%) and colleagues (12.3%). The prevalence of chronic diseases was less than 1% and alcohol and tobacco did not appear to be major coping strategies. The population appeared to be physically healthy and despite the known prevalence of probable mental distress, doctors and nurses appeared unwilling to seek healthcare. Probable barriers to seeking healthcare included confidentiality issues and the need to appear healthy to colleagues, patients and the community.

Are women ready to do HIV test?

OBJECTIVE: To identify the factors that influence the stage of change with regards to HIV testing in women (16- 45-years-old) in Westmoreland using the trans-theoretical model (TTM) of behaviour change. DESIGN AND METHODS: A structured interview-assisted questionnaire was administered to 372 pregnant and non-pregnant respondents in urban and rural areas of Westmoreland after random selection of four public health facilities. The trans-theoretical model which suggests that behaviour change process moves through five stages from pre-contemplation to maintenance was used to evaluate readiness for HIV testing. RESULTS: Most pregnant women who tested previously were at the preparation stage (78.5%) while non-pregnant women who tested previously were at contemplation (68.5%). The significant predictors of being in the action or maintenance stage among pregnant women was being 20- 24-years-old, experiencing a first pregnancy and being exposed to counselling. For women who had never tested, preparation was significantly associated with being in an unstable union (non-pregnant). No significant association was found for non-pregnant, previously tested females or for pregnant women who had never tested. CONCLUSION: The majority of women lacked self-efficacy as they were unable to maintain the behaviour and did not recognize its importance in the absence of pregnancy. Interventions are needed to target non-pregnant women, especially teenagers, women over 25-years old and women in unions. Integration of testing services into all aspects of primary healthcare, established testing protocols and simultaneous marketing to selected at-risk groups will increase the uptake of HIV testing opportunities and contribute to the control of this epidemic.

Ageing: the response yesterday, today and tomorrow.

This is an overview of the phenomenon of population ageing and ageing trends in Jamaica. It documents landmark policy achievements and responses to population ageing and analyses related social, economic and health implications, as well as, the challenges and opportunities of ageing. The interdigitations of ageing issues and public health is manifest from the early historical milestones in ageing research to the establishment of the Mona Ageing and Wellness Centre to the continuing collaborative work with international agencies such as the World Health Organization (WHO). The contribution of the University of the West Indies (UWI) through the Department of Community Health and Psychiatry to ageing research and policy is documented.